重症急性呼吸综合征的临床特点与分期

目的 通过分析重症急性呼吸综合征(SARS)患者的临床特点,制订SARS的临床分期。方法 回顾性分析1170例SARS患者症状体征、实验室检查、影像学结果在病程不同时期的特点。结果 发热为SARS患者的首发症状,自然热程14d左右。呼吸道症状和感染中毒症状在病程第2周出现或维持一个高峰,3周后恢复正常。低氧血症是其特点之一,动脉血氧分压、脉搏血氧饱和度在病程前2周明显下降,2周后逐渐恢复。100％患者X线胸片异常,病程第1天即可出现,前2周明显加重,2周后开始恢复。淋巴细胞亚群计数在发病初期全面下降,2～3周后恢复正常。结论 典型SARS病程约4周,1～7d为早期,8～14d为极期,15～28d为恢复期。

The clinical characteristics and staging of severe acute respiratory syndrome

OBJECTIVE: To investigate the clinical characteristics and to initiate a clinical staging of severe acute respiratory syndrome (SARS). METHODS: Retrospective analysis was conducted in the clinical symptoms, physical signs and the results of laboratory examinations from 1170 cases with SARS in Beijing, and the clinical characteristics in different stages of the disease were compared. RESULTS: The initial symptom of SARS was pyrexia and the temperature was > 38 degrees C. The natural course of fever was about 14 days. In almost all cases, the respiratory symptoms and systemic toxic manifestations were observed. They came to a climax at the second week and then decreased or nearly disappeared after the third week. The physical signs of SARS were not obvious. The moist rales were observed in 43.3% of patients. Hypoxemia was a common characteristic in SARS. The decrease in partial pressure of oxygen in artery and oxygen saturation in pulse oximeter with normal partial pressure of carbon dioxide was found in most patients at the second week. Abnormal chest X-ray including infiltration and consolidation shadows were seen in 100% of patients. The abnormal images could be found at the first day, enlarged during the second week (to a climax at the 8th or 9th day), and then recovered from the 2 week. The amounts of CD(4)(+), CD(8)(+), and CD(3)(+) of peripheral blood were decreased at the early stage and recovered after 2 or 3 weeks. Some patients suffered from temporary multiple organ dysfunctions (mainly impairments of liver and myocardium). CONCLUSION: The main clinical manifestations of SARS included respiratory and systemic toxic symptoms. The typical course of the disease was about 4 weeks. The first week could be considered as early stage, the second week as fastigium stage, and from the next two weeks as recovery stage.